What is the “advantage” in Medicare Advantage?

All the clamor over cuts in MA reimbursement and audits of MA payments has caused us to lose track of what this program can do that traditional Medicare cannot. 

Risk adjustment has made direct, careful clinical assessment of MA members a financial imperative.  The Stars program has made measuring quality of care for those members a necessity. MA plans have the unique advantage of being able to:  1) merge claims and clinical data in a single, actionable database and 2) use that data to positively impact the care their members receive. 

The recent push to prospectively evaluate MA members’ chronic care conditions and the care they receive for those conditions does both—and traditional Medicare cannot do either.

This is a marvelous example of a situation where CMS is using financial incentives to effectively drive care for America’s seniors.  Maybe there really  is a strong case for moving more Medicare beneficiaries into this well-designed model.

1 Comment
  1. Thanks for echoing my thoughts on MA plans! The quality oversight that managed care has “enjoyed” for almost 20 years pales in comparison to the conversation just starting in the FFS system. It’s like the govt just woke up from a long sleep LOL I’ve often wondered why – with the growing deficit and looming insolvency of Medicare – the govt doesn’t run, not walk, to MA plans! (Ok, I don’t wonder, really…. I know why….)

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